Tracheobronchial reconstructions with bronchoplastic closure: an alternative method in treatment of bronchogenic carcinoma involving the carina or tracheobronchial angle.
Tracheobronchial reconstructions with bronchoplastic closure: an alternative method in treatment of bronchogenic carcinoma involving the carina or tracheobronchial angle.
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DOI：
10.1016/j.jtcvs.2012.04.003
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发表时间：
2012-08
期刊：
影响因子：
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通讯作者：
Wen-xin He;Bing-qiang Han;Ming Liu;Peng Zhang;Jiang Fan;Nan Song;G. Jiang
中科院分区：
文献类型：
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作者：
Wen-xin He;Bing-qiang Han;Ming Liu;Peng Zhang;Jiang Fan;Nan Song;G. Jiang
我们的目的是总结我们的经验与支气管重建支气管成形术关闭气道缺损后，非圆周切除支气管肺癌涉及隆突或气管支气管angle. METHODS从1990年1月至2005年12月，所有患者进行气管支气管重建支气管成形术关闭支气管肺癌涉及隆突或气管支气管角。回顾性收集患者的临床资料，包括人口统计学特征、术后并发症的发生率和生存率。共有40例患者符合条件，其中23例接受右肺切除术，6例接受右上叶切除术，11例接受左肺切除术，伴有气管下侧壁切除术或中央定位肿瘤的部分隆突切除术。气道缺损范围为0.5 × 2 cm至2 × 4 cm，累及气道周长的50%。术后20%（8/40）支气管边缘有镜下残留病变。术后肺不张2例（5.0%），心律失常2例（5.0%），支气管胸膜瘘2例（5.0%），气道狭窄1例（2.5%）。30天死亡率为2.5%（1/40）。40例患者的中位生存期为18.5个月，1年、3年和5年的累积生存率分别为72.2%、26.6%和21.3%。结论：对于累及气管支气管角或隆突的晚期支气管肺癌，使用支气管成形术闭合支气管支气管重建可能是闭合巨大中央气道缺损的合理选择。避免气管袖状全肺切除术和气管侧壁或隆突的有限切除。
OBJECTIVEOur objective was to summarize our experience with tracheobronchial reconstructions using bronchoplastic closure for airway defects after noncircumferential resections of bronchogenic carcinoma involving the carina or tracheobronchial angle.METHODSFrom January 1990 to December 2005, all patients who underwent tracheobronchial reconstructions with bronchoplastic closure for bronchogenic carcinoma involving the carina or tracheobronchial angle were included. The clinical data for patients were collected retrospectively, including demographic characteristics, occurrences of postoperative complications, and survival.RESULTSA total of 40 patients were eligible, including 23 who had right pneumonectomies, 6 who had right upper lobectomies, and 11 who had left pneumonectomies, associated with lower lateral wall of the trachea resections or with partial carinal resections for centrally localized tumors. The airway defects ranged from 0.5 × 2 cm to 2 × 4 cm and involved up to 50% of the airway circumference. Microscopic residual disease was found postoperatively at the bronchial margin in 20% (8/40). Of 40 patients, 2 (5.0%) had pulmonary atelectasis develop, 2 (5.0%) arrhythmia, 2 (5.0%) bronchopleural fistula, and 1 (2.5%) airway stenosis after operation. Thirty-day mortality was 2.5% (1/40). Median survival for 40 patients was 18.5 months with a cumulative survival of 72.2%, 26.6%, and 21.3% at 1, 3, and 5 years, respectively.CONCLUSIONSTracheobronchial reconstruction using bronchoplastic closure might be a reasonable option for closing massive central airway defects for advanced bronchogenic carcinoma involving the tracheobronchial angle or carina, avoiding tracheal sleeve pneumonectomy with limited excision of the lateral wall of the trachea or carina.